Healthcare Provider Details

I. General information

NPI: 1902329469
Provider Name (Legal Business Name): MEDALLUS & VACHAROTHONE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LAMOILLE HWY
ELKO NV
89801-4321
US

IV. Provider business mailing address

10433 S REDWOOD RD STE 2
SOUTH JORDAN UT
84095-8502
US

V. Phone/Fax

Practice location:
  • Phone: 775-400-1510
  • Fax: 775-376-9578
Mailing address:
  • Phone: 801-260-1919
  • Fax: 801-260-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE ARAGON
Title or Position: COMPLIANCE ADMIN ASST/ CRED LIAISON
Credential:
Phone: 801-260-1919